Provider Demographics
NPI:1215013917
Name:RETHWILL, KURT VON (DC)
Entity type:Individual
Prefix:
First Name:KURT
Middle Name:VON
Last Name:RETHWILL
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1445 SE PINE STREET
Mailing Address - Street 2:
Mailing Address - City:ROSEBURG
Mailing Address - State:OR
Mailing Address - Zip Code:97470-4017
Mailing Address - Country:US
Mailing Address - Phone:541-672-8984
Mailing Address - Fax:
Practice Address - Street 1:1445 SE PINE ST
Practice Address - Street 2:
Practice Address - City:ROSEBURG
Practice Address - State:OR
Practice Address - Zip Code:97470-4017
Practice Address - Country:US
Practice Address - Phone:541-672-8984
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-27
Last Update Date:2012-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR27 2767111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORU30169Medicare UPIN
OR0000QGFTHMedicare ID - Type Unspecified